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See a sample rate comparisonCPT 95117 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Professional Services For Alle, Professional Services For Allergen Immunotherapy Notincluding Provision Of Allergenic Extracts Two Or More Injections
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Allergy and Clinical Immunology Procedures |
| Common Place of Service | 11 - Office 72 - Rural Health Clinic |
| Common Modifiers | 59 - Distinct Procedural Service SA |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.36 national non-facility rate (2026) · View Medicare rates for 95117 |
| Medicaid Fee Schedule | $10.495 median of the 8 states in the free preview · View Medicaid rates for 95117 |
National average reimbursement for CPT 95117 by major payers:
$16.69
$15.10
$15.98
$17.94
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CPT 95117
5 of 25 sample ratesHigher to lower in this preview
Elisabeth Graham
Duke University Health System Inc
$26.76Published rateKathryn Donato
Duke University Health System Inc
$24.00Published rateLawrence Aristizabal
Duke University Health System Inc
$24.00Published rateEric Carlsen
Duke Health Integrated Practice Inc
$21.71Published rateJohn Picano
Slocum Dickson Medical Group PLLC
$13.46Published rate
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See a sample payer proposalCPT 95117 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95117 code is part of the Medicine Services and Procedures services used for Allergy and Clinical Immunology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 95117 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95115-CPT | Low | Professional Services For Alle, Professional Services For Allergen Immunotherapy Notincluding Provision Of Allergenic Extracts Single Injection |
| 95117-CPT | Low | Professional Services For Alle, Professional Services For Allergen Immunotherapy Notincluding Provision Of Allergenic Extracts Two Or More Injections |
| 95120-CPT | Low | Immunotherapy One Injection, Professional Services For Allergen Immunotherapy In The Office Or Institution Of The Prescribing Physician Or Other Qualified Health Care Professional Including Provision Of Allergenic Extract Single Injection |
| 95125-CPT | Low | Immunotherapy 2 Injections, Professional Services For Allergen Immunotherapy In The Office Or Institution Of The Prescribing Physician Or Other Qualified Health Care Professional Including Provision Of Allergenic Extract 2 Or More Injections |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95117. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95117 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
To find the cost of a specific medical procedure or service, you generally need to know the CPT (Current Procedural Terminology) code for that service and your geographic location. For accurate and specific pricing information based on your situation, it is recommended to use tools designed for this purpose, such as Payerprice.
For specific fee schedule information based on CPT codes and your location, you should use a dedicated fee schedule lookup tool. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get relevant pricing information.
Payerprice is a service that provides a fee schedule lookup tool. It allows users to search for the cost of medical procedures and services using CPT codes and specific geographic locations, helping them understand potential healthcare costs more transparently based on their unique needs.
While CMS (Centers for Medicare & Medicaid Services) provides extensive data and information regarding Medicare and Medicaid reimbursement, for looking up specific fee schedules based on CPT codes and your particular location for individual situations, it is recommended to use a tool like Payerprice. Payerprice's fee schedule lookup tool is designed for users to search with CPT codes and specific locations, offering more direct access to relevant pricing data.
CPT (Current Procedural Terminology) codes are a standardized set of five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are essential for accurate billing, processing claims, and communicating medical procedures to payers and other stakeholders.